Radiological and functional outcome of unstable intertrochanteric fractures treated with proximal femoral locking plate

Background: Intertrochanteric fracture is a common orthopaedic injury sustained in elderly population because of osteoporosis and trivial fall. Life threatening systemic complications occur mainly due to immobility.Methods: We included 62 patients (40 males and 22 females) of unstable intertrochanteric fracture (AO 31 A2 and A3) attending Department of Orthopaedics. They were all subjected to surgical treatment with proximal femoral locking plate. Patients were followed up at 3rd, 6th and 12th month for outcomes variables i.e.; functional (Harris hip score, Palmer and Parker mobility score) and radiological outcomes (neck shaft angle, loss of reduction, union and implant related complications). Statistical analysis was done using Friedman’s test after calculating the data in terms of mean and median using SPSS 20 software.Results: Mean age of our patients was 64 years, 40 were males and 22 females. 50 patients sustained fracture due to trivial fall and 12 due to RTA. 35 out of 62 patients had medical co-morbidites. 26 patients needed open reduction of fracture and 36 were close reduced. 22 of patients had severe comminution (AO A 3 III type). Average blood loss was 254 ml. Mean degree of loss of reduction was 5 degrees in 6th month and 4 degrees in 12th month. Union was achieved in 48 out of 50 patients at 12th month. Most of the patients achieved fair to good functional outcome scores at 12th month of follow up. We noticed difficulties in fracture reduction as well as complications related to implant.Conclusions: PFLP is an effective implant in comminuted intertrochanteric fractures with broken lateral wall. Complications can be minimised by following principles of locking plate meticulously.

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Functional analysis of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20175662 ◽

2017 ◽

Vol 4 (1) ◽

pp. 141

Author(s):

Sivabalan T. ◽

Thirunarayanan V. ◽

Senthil Kumar S. ◽

Ramprasath D. R. ◽

Basheer Ahmed S.

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

The Elderly ◽

Fracture Pattern ◽

Harris Hip Score ◽

Bipolar Hemiarthroplasty ◽

Intertrochanteric Fractures ◽

Excellent Outcome ◽

Unstable Intertrochanteric Fracture ◽

Cemented Bipolar Hemiarthroplasty

Background: Intertrochanteric fracture is one of the most common fractures among the elderly osteoporotic population, constituting about 50% of hip fractures. These fractures are managed either by fixation using dynamic hip screw (DHS), proximal femur nail (PFN) or by replacement, based on the stability of fracture pattern, age of the patient, quality of bone and associated co-morbid conditions. Prosthetic replacement which is routinely done for femoral neck fractures requires modification when done for trochanteric fractures to improve stability. This study aims to analyse the short term functional outcome of cemented bipolar hemiarthroplasty with medial calcar augmentation for unstable intertrochanteric fractures in elderly.Methods: Our study includes 60 patients of age more than 70 years admitted in our institution during June 2012 to September 2016 with unstable intertrochanteric fractures. All patients operated through posterior approach to hip and cemented hemiarthroplasty with medial calcar augmentation with bone graft was done. Patients were followed up for an average of period of 2 years. Functional outcome was evaluated with Harris Hip score.Results: 28% of cases had excellent outcome. 43% of cases had good and 23% of cases had fair outcome. 2% of cases ended with poor outcome. The in-hospital mortality rate was 3.3%. The survival rate of the patients in this study at the end of one year is 85%. Conclusions: Cemented bipolar hemiarthroplasty with medial calcar augumentation can be considered as a good primary option for elderly unstable intertrochanteric fracture patients with osteoporotic bones and associated co-morbidities.

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EVALUATE INTRAOPERATIVE VARIABLES AND POSTOPERATIVE OUTCOMES OF INTERTROCHANTERIC FRACTURES WITH VULNERABLE/ BROKEN LATERAL WALL MANAGED WITH SHORT AND LONG CEPHALOMEDULLARY NAIL

10.36106/gjra/5201498 ◽

2021 ◽

pp. 36-37

Author(s):

Rahul Kumar ◽

Wasim Ahmed ◽

Indrajeet Kumar

Keyword(s):

Blood Loss ◽

Functional Outcome ◽

Postoperative Outcomes ◽

Treatment Modalities ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Duration Of Surgery ◽

One Year ◽

Lateral Walls

Purpose: To evaluate intraoperative variables and postoperative outcomes of intertrochanteric fractures with vulnerable/broken lateral walls managed with short and long cephalomedullary nails. Materials & Methodology: Twenty prospective cases of patients treated with LCMN and twenty retrospective cases treated with SCMN were included in the study. Intraoperative variables compared were duration of surgery, blood loss during surgery, and surgeon's perception of surgery. Functional outcome was evaluated by Parker Palmer mobility score (PPMS), Harris hip score (HHS), and Short Form-12 at one year. Radiological assessment were done at six months/one year to look for progress of fracture union, change in neck-shaft angle, and any signs of implant failure. Results: Duration of surgery (p<0.001), blood loss during surgery (p=0.002), and surgeon's perception of surgery (p=0.002) were signicantly more in the LCMN group. The LCMN group had a better functional outcome. HHS for the LCMN group was 89.15±9.53, and for the SCMN group it was 81.53±13.21 (p=0.021). PPMS for LCMN group was 8.85± 0.67 and for the SCMN group was 7.53±1.807 (p=0.005). There were four implant failures in the LCMN group compared to none in the SCMN group (p=0.036). Conclusion: Both SCMN and LCMN are effective treatment modalities for unstable intertrochanteric fractures with vulnerable/broken lateral walls. In the absence of more extensive study and long-term follow-up, the superiority of one implant over the other cannot be recommended.

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Functional and Radiological Outcome of Unstable Intertrochanteric Fracture in Old Age Treated with Proximal Femoral Nail Antirotation-2

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/47653.14751 ◽

2021 ◽

Author(s):

OP Jamshad ◽

Jacob Mathew ◽

Raju Karuppal

Keyword(s):

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Biological Reduction ◽

Neck Shaft Angle ◽

Femoral Nail ◽

Unstable Intertrochanteric Fracture ◽

Shaft Angle ◽

The Mean ◽

Proximal Femoral Nail Antirotation

Introduction: Intertrochanteric fractures are prevalent in the elderly, which leave patients with functional restrictions. Proximal Femoral Nail Antirotation-2 (PFNA) was developed to achieve better fixation strength, particularly in the presence of osteoporotic unstable intertrochanteric fractures. Aim: To evaluate the role and result of PFNA-2 in the treatment of unstable intertrochanteric fractures in geriatric patients. Materials and Methods: A prospective analytical study was conducted in 35 patients with unstable intertrochanteric fractures. They were followed-up clinically and radiologically for one year. The quality of fixation was assessed, by neck-shaft angle and Tip Apex Distance (TAD). A functional assessment was done with the Harris Hip Score (HHS). Results: The mean follow-up period was 13 months (range, 12-14). The mean age of patients was 65.6 years and the majority were female patients (62.85%). Functional results according to modified HHS were found to be excellent in 6 (17.1%) patients, good in 14 (40%) patients, fair in 12 (34.3%) patients and poor in 3 (8.6%) patients. The average HHS in this study was 81.6. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 16.0. Conclusion: PFNA-2 helps in achieving biological reduction and good stability which enables early mobilisation and prevention of excessive collapse. A good functional outcome could be achieved when the radiological parameters are restored, i.e., TAD <25 mm and neck-shaft angle difference <5° (compared to the opposite side).

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Randomized control trial comparing the functional outcomes of dynamic hip screw and locking plate dynamic hip screw in intertrochanteric fractures of femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20201090 ◽

2020 ◽

Vol 6 (3) ◽

pp. 525

Author(s):

Kiran Ramachandran ◽

Dileep Sasidharan ◽

Oommen Mathew

Keyword(s):

Functional Outcomes ◽

Locking Plate ◽

Dynamic Hip Screw ◽

Research Centre ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Operative Care ◽

Significant Difference ◽

Hip Screw

Background: The objective of the study was to compare the functional outcomes of intertrochanteric fractures of the femur treated with dynamic hip screw (DHS) and locking plate DHS in elderly.Methods: 48 participants (23 in DHS and 25 in locking plate DHS) aged ≥ 50 years with intertrochanteric fracture of femur were enrolled in the present randomized open label parallel group trial conducted at Pushpagiri Institute of Medical Sciences and Research Centre during a period of 1 year. Open, pathological, other fractures in the same limb and participants with neurological involvement were excluded. Standard of care (pre and post-operative care) was given to all participants. Sociodemographic, radiological findings, fracture type and Singh’s index were recorded at baseline, 6 weeks, 3 and 6 months. Study commenced after approval from Institutional Ethics Committee and written informed consent was obtained from all study participants. Participants were randomized in 1:1 ratio using coin flip method. Quantitative variables were expressed means and medians and qualitative variables were expressed as proportions. Tests of significance were independent sample t test, Mann Whitney U test, Friedman test and Chi square test.Results: Between DHS and locking plate DHS, no significant difference in baseline parameters, neck shaft angle, tip apex distance, shortening, Harris hip score, range of motion score and length of hospital stay were observed.Conclusions: The functional outcomes and complications between DHS and locking plate DHS were not significantly different.

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Functional outcome of unstable intertrochanteric fractures managed with proximal femoral nail: a prospective analysis

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184391 ◽

2018 ◽

Vol 4 (6) ◽

pp. 945

Author(s):

C. Joney Mandice ◽

Raship Khan ◽

Heber Anandan

Keyword(s):

Functional Outcome ◽

Hip Fractures ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Intertrochanteric Fractures ◽

Femur Fractures ◽

Efficient Management ◽

Femoral Nail ◽

Early Return ◽

Unstable Intertrochanteric Fracture

Background: Hip fractures are a growing concern for the orthopedic surgeons all over the world because the incidence of hip fractures is increasing dramatically and these fractures impose a significant challenge in their efficient management. The aim of the study was to prospectively analyze the functional outcome of unstable intertrochanteric fractures managed with ‘proximal femoral nail’.Methods: In our institution, we have selected 24 cases of unstable intertrochanteric fractures for this prospective study. All cases enrolled were managed with the proximal femoral nail. These cases were studied from the mechanism of injury, classification, and treatment with the proximal femoral nail and their surgical and functional outcome with or without residual comp.Results: Patients were followed up for an average period of 8.58 months. The mean Harris hip score was 88.75 at 6th month. The score was excellent in 12 patients, good in 10 patients, fair in 1 patient and poor in 1 patient. In our study of 24 patients with unstable intertrochanteric fracture, the average age incidence was 54.64 years. In the present study male: female was 5:3.Conclusions: In unstable proximal femur fractures, PFN is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work.

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Outcome of external fixator in the treatment of intertrochanteric fracture in elderly patients with co-morbidities

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i1.29918 ◽

2019 ◽

Vol 7 (1) ◽

pp. 3-7

Author(s):

Deepak Kumar Dutta ◽

R, Sinha

Keyword(s):

Elderly Patients ◽

Functional Outcome ◽

External Fixator ◽

Intertrochanteric Fracture ◽

Harris Hip Score ◽

External Fixators ◽

Intertrochanteric Fractures ◽

Early Ambulation ◽

Medical Comorbidities ◽

Mean Time

Background and Objectives: Incidence of intertrochanteric fracture is rising because of increasing number of elderly. They tend to have many comorbidities of different systems; therefore, major surgeries are not possible at times. In these patients, external fixator can be an option as it promotes early ambulation, thereby preventing recumbency-associated complications. Material and Methods: Elderly patients of interetrochanteric fracture and with medical comorbidities were managed with external fixator. Functional outcome was measured by Harris Hip Score (HHS) on first post-operative day and in follow ups on 4, 12, and 24 weeks. Results: Thrity patients (19 males, 11 females), of mean age 77.63 years (SD=9.06) were studied. HHS scores steadily increased from 37.6±5.28 on the first post-operative dayto 49.43±6.9 on 4 weeks, 59.83±7.17 on 12 weeks, and 72.47±4.17 on 24 weeks. The changes were all very highly significant (all p=0.000). Mean time taken to union was 14.67±2.28 weeks. None of the patients had recumbency-related complications. Conclusion: External fixators for intertrochanteric fractures in medically comorbid elderly patientsis effective in promoting ambulation and preventing recumbency-related complications.

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AO/OTA 31A2 and 31A3 Intertrochanteric Fractures Managed by Proximal Femoral Nail Antirotation (PFNA)

10.53350/pjmhs2115102616 ◽

2021 ◽

Vol 15 (10) ◽

pp. 2616-2618

Author(s):

Zamir Hussain Tunio ◽

Rizwan Ali Jhatiyal ◽

Muhammad Azeem Akhund ◽

M. Kashif Abbasi ◽

S. Muhammad Ali ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Proximal Femoral Nail ◽

Harris Hip Score ◽

Psychiatric Disease ◽

Unstable Fracture ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Intramedullary Device ◽

Unstable Intertrochanteric Fracture ◽

Proximal Femoral Nail Antirotation

Aim: To study the clinical and radiological outcome of unstable intertrochanteric fracture AO/OTA 31A2, 31A3 fixed by proximal femoral nail antirotation Study design: Descriptive cross sectional study. Place and duration of study: Department of Orthopedic Surgery and Traumatology, Pir Abdul Qadir Shah Jilani Institute of Medical Sciences, Gambat, Sindh from 1st January 2016 to 31st December 2019. Methodology: Forty four cases having intertrochanteric fracture AO/OTA 31A2, 31A3 with age ranging from 18 year to 55 year of either gender were selected; patients having close fracture, who were willing were included in the study, while patients older than 55 year and younger than 18 year, AO/OTA 31A1 fracture, open fracture, bilateral injuries, smoker, alcoholic, drug addicted, poly-trauma, pathological fracture and history of poor compliance, psychiatric disease were excluded. Results: There were 26(59.09%) males and 18(40.91%) females with mean age was 41.3±7.7 years. Regarding classification; AO/OTA 31A2 were 33 (75%), and 31A3 were 11 (25%). Mean time for union was 18.5±3.55 weeks. The average time of follow-up was 48.5±6.6 weeks. Harris Hip Score was excellent (90-100) in 31(70.45%), good (80-89) in 7(15.91%), fair (70-80) in 3 (6.81%) and poor (<70) in 3 (6.81%). Conclusion: Intramedullary device proximal femoral nail antirotation can be labelled as implant of choice for unstable intertrochanteric fractures AO/OTA 31A2, 31A3, with fruitful clinical and radiological outcomes, and with fewer complications. Hip Harris score was excellent-good in 86% of the patients. Key words: Proximal femoral nail antirotation (PFNA), AO/OTA 31A2, 31A3, Intertrochanteric, unstable fracture

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Prospective study of prognosis of intertrochanteric fractures with lateral wall involvement as compared to intertrochanteric fractures with intact lateral wall

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20195806 ◽

2019 ◽

Vol 6 (1) ◽

pp. 129

Author(s):

Amit Bansal

Keyword(s):

Functional Outcome ◽

Lateral Wall ◽

Mechanical Complication ◽

Intertrochanteric Fractures ◽

Neck Shaft Angle ◽

Shaft Angle ◽

Tip Apex Distance ◽

Specific Fixation ◽

Primary Lateral ◽

Worse Prognosis

Background: Intertrochanteric fractures with fracture lateral wall (FLW) are biomechanically unstable fractures.Methods: 40 patients who met inclusion criteria underwent surgery. Post-operatively patients were followed up for a minimum period of 24 weeks. Radiological and functional assessment was done post-operatively. Endpoints of fracture were studied thoroughly.Results: Secondary lateral wall fractures were common than primary lateral wall fractures. Functional outcome was found to be poor in FLW than intact lateral wall (ILW) group (p=0.01). HHS of ILW fracture was 70, while in FLW it was 46. Displacement was found to be a better radiological parameter to assess reduction quality (p=0.02) than neck shaft angle. Implant position with Cleveland method was found to be a better predictor of fixation quality than tip apex distance. There were 6 (15%) mechanical failures. Screw cut out (3 cases) found to be most common mechanical complication (7.5%). There were four failures (33%) in FLW. Secondary lateral wall fractures were found to have poor prognosis than primary lateral wall fractures. A2.3 was found to have more chance of conversion to A3 due to thinned out lateral wall. Many of them happened when DHS was the implant of choice (60%).Conclusions: Functional outcome of FLW is poor than ILW. Secondary lateral wall fractures have worse prognosis than primary lateral wall fractures. Fragment specific fixation is difficult in secondary lateral wall fractures as compare to primary lateral wall fracture, due to higher comminution.

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A study to assess proximal femoral nailing versus dynamic hip screw device in surgical management of intertrochanteric fractures: a comparative study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20184719 ◽

2018 ◽

Vol 5 (1) ◽

pp. 23

Author(s):

E. S. Radhe Shyam ◽

K. Ashwin

Keyword(s):

Functional Outcome ◽

Intertrochanteric Fracture ◽

Trochanteric Fracture ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Technical Failure ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Fracture Management ◽

Hip Screw

Background: The incidence of inter trochanteric fracture is expected to have doubled by 2040. Inter trochanteric fractures account for about 45% to 50% of all hip fractures in the elderly populationand out of these, near about 50% to 60% are classified as unstable intertrochanteric fractures. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure. This study as performed to assess functional outcome with dynamic hip screw and proximal femoral nail in intertrochanteric fracture management.Methods: It was prospective observational study done for a period of 1year from January 2016-January 2017 among patients who attended OPD or emergency department with intertrochanteric fracture. Two different implants were used dynamic hip screw (DHS) and proximal femoral nail (PFN).Results: Excellent results in functional outcome was more in case of PFN (66.6%) compared to DHS (50%). The type of trauma in DHS group was road traffic accident in 38.8%, domestic fall in 50% and others such as assault was in 11.1% while in PFN group intertrochanteric fracture was seen in 61.1% due to domestic fall.Conclusions: The functional outcome was more better with proximal femoral nail (PFN) compared to dynamic hip screw (DHS). Therefore, proximal femoral nail (PFN) should be preferred for management of intertrochanteric fractures.

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Dynamic Hip Screw with Trochanter-Stabilizing Plate Compared with Proximal Femoral Nail Antirotation as a Treatment for Unstable AO/OTA 31-A2 and 31-A3 Intertrochanteric Fractures

BioMed Research International ◽

10.1155/2020/1896935 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Chun-Wei Fu ◽

Ji-Ying Chen ◽

Yueh-Ching Liu ◽

Kuang-Wen Liao ◽

Yung-Chang Lu

Keyword(s):

Intertrochanteric Fracture ◽

Operation Time ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Intertrochanteric Fractures ◽

Residual Pain ◽

Unstable Intertrochanteric Fracture ◽

Hip Screw ◽

Proximal Femoral Nail Antirotation ◽

Im Nailing

Background. The dynamic hip screw (DHS) with the addition of an angular stable trochanter-stabilizing plate (TSP) has been considered the ideal treatment for the unstable intertrochanteric fracture type. However, there have been few comparisons between DHS+TSP augmentation with intramedullary (IM) nailing. The aim of this retrospectively registered study was to compare the clinical outcomes of patients with the unstable type of intertrochanteric fractures treated with DHS+TSP or IM nailing (proximal femoral nail antirotation (PFNA)). Methods. From June 2013 to April 2018, 358 patients with proximal femur fracture AO/OTA type 31A2 and 31A3 treated with PFNA or DHS+TSP and followed for ≥10 months postoperatively were included. The surgical-dependent outcome evaluation included the operation time, intraoperative blood loss, postoperative decrease in hemoglobin, and blood transfusion amount. Functional status was also measured. Radiographic findings and postoperative complications were recorded and analyzed. Result. The operation time was significantly shorter in the DHS+TSP group than that in the PFNA group for both A2 and A3 fractures (A2 type: 84.0 vs.96.4 min; p<0.05; A3 type: 102.4 vs.116.1 min; p<0.05). Postoperative decrease in hemoglobin was more significant in the PFNA group than that in the DHS+TSP group for both fracture types (A2 type: −1.88 vs. −1.29 (mg/dL); p<0.05; A3 type: −1.63 vs. −1.04 (mg/dL); p<0.05). However, the patients treated with DHS+TSP had significantly more residual pain than those treated with PFNA during the final follow-up (Visual Analog Scale score, A2 type: 28.4 vs.23.2; p<0.05; A3 type: 27.5 vs.23.6; p<0.05) and complained of greater implant irritation. Conclusion. We found that DHS+TSP was associated with less operation time and less postoperative decrease in hemoglobin but more residual pain and implant irritation than those of PFNA. As a treatment for unstable intertrochanteric fracture, DHS+TSP provided ideal surgical outcomes which were not inferior to the PFNA.

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